Abstract
This study aimed to synthesize available evidence on the analgesic efficacy of buprenorphine in treating cancer pain and related adverse effects. We searched electronic databases for randomized controlled trials, assessing the efficacy of buprenorphine, regardless of delivery system. The primary endpoints were patient-reported ‘pain intensity’ and ‘pain relief’. Statistical heterogeneity among included studies was assessed with the I2 test. The summary relative risk (RR) and 95% CI were derived, if two or more studies reported the similar outcome. Sixteen RCTs (n = 1329) with buprenorphine were included: 8 transdermal (TD), 5 sublingual (SL), 2 intramuscular injection (IM) and 1 subcutaneous infusion (SC) studies; with both SL and IM routes being assessed in one study. Only a few studies reported the same outcome in a similar way, creating difficulty for pooling of the outcome data. Many studies had a high risk of bias. In 2 studies (n = 241), the ‘global impression change’ was significantly different between TD buprenorphine and the combined placebo and morphine (RR 1.35, 95% CI 1.14-1.59; I2: 42%); the ‘number-needed-to-treat’ (NNT) was 4.9 (95% CI: 3.1-10.9). In 2 studies (n = 331), ‘requirement for rescue SL buprenorphine’ was comparable between TD buprenorphine and placebo (RR 1.25, 95% CI 0.71-2.18; I2 : 40%). In 2 studies (n = 141), ‘incidence of nausea’ was less in TD buprenorphine (RR: 0.38, 95% CI: 0.2-0.71, I2: 0%, NNT: 9.3, 5.6-28.5). Due to the small number of participants in a small number of studies, the results of the present review provide insufficient evidence to position adequately the use of buprenorphine in treatment of cancer pain. Large multicenter RCTs that compare TD buprenorphine with standard analgesic treatment is needed to position TD buprenorphine in the therapeutic armamentarium of cancer pain treatment.Electronic supplementary materialThe online version of this article (doi:10.1186/2193-1801-3-87) contains supplementary material, which is available to authorized users.
Highlights
Worldwide cancer is one of the leading causes of morbidity and mortality
Thirty six that examined the efficacy of buprenorphine were potentially relevant
Reported outcomes in the i analysed studies included a number of validated scales subjectively used for pain intensity and/or pain relief (e.g. visual-analogue scales (VAS), verbal rating scales (VRS), numerical rating scales (NRS), questionnaires), requirement for rescue drugs, duration of pain-free sleep and presence of Adverse event (AE)’s and Serious adverse events (SAE)’s
Summary
Worldwide cancer is one of the leading causes of morbidity and mortality. In 2012 new cases of cancer was estimated to be 14.1 million per year (ICRC 2012) and is expected to climb to 19.3 million per year in 2025 (WHO 2011; ICRC 2012). The estimated cancer-related deaths was 8.2 million in 2012 (ICRC 2012). The majority of all cancers (56.8%) and cancer deaths (64.9%) in 2012 occurred in less developed countries (ICRC 2012). When there is local and metastatic spread of cancer, complications arise and pain is an inevitable outcome. The use of opioids has been the mainstay for treating cancer pain (Hanks 1991)
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